What It’s Like When You’re an American Using Britain’s NHS

I’ve spent half my life in the US and half of it in the UK, so I’m used to both countries’ healthcare systems. I recently returned to London after 20 years in America, and after a few doctors’ appointments I’ve come to see the NHS through American eyes.

[2] The National Health Service is, as all Americans know and fear, a completely public “socialized medicine”system. It’s dramatically different from the US’s patchwork system of private providers and insurance companies.

[3] I’ve now used both systems for about two decades each, so I feel I have a pretty good handle on the main contrasts.

這么多年，我一半時間在美國，一半時間在英國，因此對兩國的醫(yī)療體系都很熟悉。在美國待了20年后，最近我回到了倫敦。體驗了幾次預(yù)約看病后，我可以從美國人的視角說說英國的醫(yī)療服務(wù)。

[2]美國人盡皆知且深感惶恐的一點(diǎn)就是，英國國民醫(yī)療服務(wù)（以下簡稱NHS）是一個完全公共的“社會化醫(yī)療”系統(tǒng)。美國則完全不同，其醫(yī)療系統(tǒng)是由私立醫(yī)療服務(wù)機(jī)構(gòu)和保險公司拼湊而成。

[3]兩種醫(yī)療體系我各使用了將近20年，因此很清楚兩者之間的明顯差異。

“This Rolls Royce isn’t moving fast enough!”

[4] The context here is that the NHS just released its most recent stats on accident and emergency room waiting times. The headline number is that 84%of patients are seen within four hours.In the UK, this is regarded as a huge failure—the standard the NHS is supposed to meet is 95% of patients in four hours. The UK media went into a fury about it, and some hospitals have begun postponing and rescheduling some non-emergency procedures in order to get those waiting times down.In the US, having sat in many an ER waiting room for hours at a stretch, the idea of a hospital seeing nearly 9 out of 10 patients in four hours would be regarded as a miracle. Bear in mind that within that four-hour period the NHS doctors are triaging1源自triage：患者鑒別分類；治療類選法〔根據(jù)緊迫性和救活的可能性等在戰(zhàn)場上決定哪些人優(yōu)先治療的方法〕。patients: If you get hit by a bus, you’re going to see someone instantly. If you broke a fi nger because you fell over while drunk at the pub, you’re probably going to wait at the back of the line. It’s not like people are literally bleeding to death while they wait for attention (although the British media loves it when it fi nds individual cases where that has happened).

[5] So my overall impression is that currently, the Brits’ complaints that the NHS isn’t hitting that 95% mark is akin to saying, “This Rolls Royce isn’t moving fast enough!”

“這輛勞斯萊斯跑得不夠快！”

[4]這里說的是NHS剛剛發(fā)布了急診室等候時間最新數(shù)據(jù)，總體數(shù)據(jù)顯示，84%的病人能在4小時內(nèi)得到治療。這在英國人看來是一個巨大的失敗——NHS制定的標(biāo)準(zhǔn)是95%的急診病人在4小時內(nèi)看上病。英國媒體對此怒不可遏，一些醫(yī)院于是開始將一些不緊急的診療推遲或改期以減少就診等待時間。在美國，我有過多次在急診候診室一連等待好幾個小時的經(jīng)歷，聽到有醫(yī)院在4小時內(nèi)為十之八九的病人診治，簡直像聽到了奇跡。別忘了在那4個小時里，NHS的醫(yī)生還要對患者進(jìn)行鑒別分類：你如果是被汽車撞了，能夠立即得到診治；而要是你在酒吧因為醉酒跌倒而摔斷了手指，那可能只能排在后面了。這并不是說病人在候診時真的會流血致死（盡管英國媒體總是熱衷于報道這樣的個案）。

[5]所以，我的總體印象是，英國人抱怨NHS沒有達(dá)成95%這個標(biāo)準(zhǔn)，就類似于有人說“這輛勞斯萊斯跑得不夠快！”

Show up when you’re told to—or else.

[6] The fi rst major difference from the patient’s point of view is what happens when you call your doctor for a routine appointment. My specific health issue was that I thought I was going slightly deaf, and wanted it checked out.

I’m a dual US/UK citizen, so I qualify for NHS treatment. Here’s what happened to me.

[7]In America, you call your doctor and request an appointment when it’s convenient for you.They might ask you what’s wrong with you, presumably to make sure it’s not something that requires immediate treatment. But basically, it’s fi rst come, fi rst served, regardless of how important it is. Usually, you can pick an appointment time that’s convenient for you if it is not an emergency.

[8]In the UK, I was given an appointment whether I liked it or not.I called and leave a message. Within an hour or two a nurse practitioner called me back and asked me a few questions about my problem over the phone. Then they said:Come in at 9am on Thursday. There was no choice over appointment times—the assumption is that if you’re ill, you’re going to come to the doctor when they say.

[9] At first I found this jarring. In America,I get to choose whenI see the doctor!In Britain, I better show up when I’m told. But the appointment came quickly, as the local health authority in London has targets it needs to meet. Ultimately, I saw the logic of it: This is a public health system. It needs to manage its costs and services.If you’re really sick, you’ll show up.If you only want to show up when it’s convenient for your schedule, then how sick are you, really?

規(guī)定時間就醫(yī)——不然另約。

[6]從病人的角度看，兩種系統(tǒng)的最大差異首先就體現(xiàn)在電話約診的流程上。以我為例，我之所以想看病是感覺耳朵有點(diǎn)聽不清，想檢查一下。

我有美國、英國雙重國籍，所以有資格獲得NHS的治療。以下是我的親身經(jīng)歷：

[7]在美國，你打電話給醫(yī)生，并根據(jù)自己方便的時間與醫(yī)生預(yù)約。對方可能會問你哪里不舒服，想必是為了確認(rèn)是否需要立即治療。但總的來說，無論病情如何，還是遵循“先約診先治療”的原則。通常，只要不是緊急狀況，你都可以約在自己方便的時間去看病。

[8]在英國，預(yù)約就診時間由診所指定，患者不能隨意選擇。我打電話并留了言。一兩個小時之內(nèi)，一位執(zhí)業(yè)護(hù)士回電，在電話里就我的病情問了幾個問題。然后對方說：周四早上9點(diǎn)過來。預(yù)約時間沒有選擇的余地——他們的假設(shè)是如果你病了，就會按醫(yī)生給定的時間去看病。

America is worse at on-the-day care.

[10] In America, I’ve always had a long wait to see my doctor. I have read many a back issue2back issue過期的報紙或雜志。ofNewsweekin my primary care3primary care初級保健。初級保健醫(yī)生又稱全科醫(yī)生（general practitioner），，區(qū)別于專科醫(yī)生（specialist）。/ general practitioner (GP)doctor’s office. I’ve sat there for an hour playing with my phone while the doc sees patients in the order they were booked.

[11]In the UK, I showed up at 9am and was seen instantly,at the Waterloo Health Centre. For an American, this was bizarre: My butt barely touched the seat in the waiting room before my name was called. Turns out my doc and her staff are serious about patient scheduling.

[12] This was one reason I became convinced that the NHS way of scheduling is superior: You might not get the time or date that you want, but once you’re in, you get seen super-quick.

[9]一開始我很震驚。在美國，什么時間去看病由我自己選擇！在英國我卻必須在指定的時間看病。但是很快就安排我就診了，因為倫敦當(dāng)?shù)氐男l(wèi)生部門有其需要完成的診療目標(biāo)。最終，我明白了其中的邏輯：這是一個公共醫(yī)療系統(tǒng)，其成本和服務(wù)都需要管理。如果你真的病了，就會及時就診。如果只想在自己方便的時間去看醫(yī)生，那你大概病得沒那么重吧？

美國的就診體驗較差。

[10]在美國，候診時間總是很長。我在初級保健/全科醫(yī)生辦公室里讀了很多份《新聞周刊》的過刊； 在醫(yī)生按照預(yù)約順序為病人一一診治的時候，我坐在那兒玩了一小時手機(jī)。

[11]在英國，我早上9點(diǎn)到達(dá)滑鐵盧健康中心，立即就診。對一個美國人來說這簡直異乎尋常：我剛進(jìn)候診室坐下，就被喊去見醫(yī)生了。這說明我的醫(yī)生和她的團(tuán)隊對病人的約診很重視。

[12]我確信NHS的約診服務(wù)更勝一籌，這就是其中一個原因：你可能約不到自己想要的時間，但是一旦預(yù)約了，就能超快看上病。

There is basically no paperwork with the NHS.

[13]There is a load of paperwork for patients in the US.This is easily the worst aspect of US healthcare—the billing paperwork. If you’ve ever had any health issue that required more than a simple doctor visit, you will know that it precipitates4precipitate使突然陷入（某種狀態(tài)）; 使突然發(fā)生。a seemingly never-ending series of forms, bills, and letters. You can be paying bills months, years later.And it’s almost impossible to correct a billing error. It’s stressful. I developed an intense hatred for health insurance companies in the US because of this.

[14]There was close to zero paperwork in the NHS.I filled in a form telling my doc who I was and where I lived, and that w a s p r e t t y much it. The o n l y o t h e r paperwork I got was a letter in the mail reminding me of my next appointment.They sent me a text reminder, too,which no American doc has ever done.It was incredibly refreshing.

NHS幾乎不用處理文書。

[13]在美國，病人要應(yīng)付很多表單。處理表單無疑是美國醫(yī)療體系最糟糕的一個環(huán)節(jié)。如果你曾因為某個健康問題不止一次去看醫(yī)生，就會發(fā)現(xiàn)突然需要沒完沒了地填表格、處理賬單和信函，可能數(shù)月甚至數(shù)年之后還在付賬單。此外，賬單上的錯誤幾乎不可能修改。這壓力簡直太大了，我因此十分痛恨美國的健康保險公司。

[14] NHS則幾乎沒有文書工作。我只填寫了一張表，告訴醫(yī)生我的姓名和地址，基本上就沒事了。唯一收到的文書就是一封信，提醒我不要忘記下次約診。此外，他們還發(fā)了一條短信提醒，美國醫(yī)生從來沒有這么做過，這簡直令人耳目一新。

A long wait for NHS treatment...

[15] I then made an appointment with a specialist at the Guy’s and St Thomas’Hospital in London.

In the US, I’ve always been able to see a specialist within a few days. Score one for America.

In the UK, they said “we’ll see you in January.”It was late November, six weeks or more away. This was a shock.

[16] I comforted myself with the assumption that the staff had made a decision that my condition was likely not life- or health- threatening, and had moved me to the back of the line. It was frustrating. Ultimately, I also needed to change my appointment because I had to leave the country on business, and this was quite difficult to do. I had to call a few times, basically to catch the hospital booking staff at the right time of day, in order to do it. I wished Guy’s and St. Thomas’ had an online system for this, but they don’t—just a bunch of people answering phones, most of whom don’t have access to the right appointment schedule.

[17] It was that appointment system again: You’re booked in according totheirpriority, notyours.The big lesson with the NHS is, it’s a lot easier to just show up when you’re told.

NHS 預(yù)約排隊時間長……

[15]我當(dāng)時預(yù)約了倫敦蓋伊和圣托馬斯醫(yī)院的一位專科醫(yī)生。

在美國，總能在預(yù)約后幾天之內(nèi)見到一位專科醫(yī)生。為美國加一分。

而在英國，對方會說“您1月過來吧”，其時是11月底，到1月還有6個多星期。我驚呆了。

[16]可能工作人員認(rèn)定我的情況不會危及生命或影響健康，所以把我往后排了——我用這樣一種假設(shè)安慰自己，卻還是有點(diǎn)失望。最終，由于要到國外出差，我還是得修改預(yù)約時間，而改時間非常困難。我不得不打了好幾次電話，主要就為掐準(zhǔn)時間正好找到醫(yī)院預(yù)約人員。我多希望蓋伊和圣托馬斯醫(yī)院能有一個線上預(yù)約系統(tǒng)，但他們沒有——他們只有一群接電話的人，而且大多數(shù)手上都沒有正確的預(yù)約日程表。

[17]所以，最后還是預(yù)約系統(tǒng)的問題：要根據(jù)他們的安排而非你想的時間約診。在NHS體制中看病，我所學(xué)到的重要一點(diǎn)就是，要在醫(yī)院給你約定的時間去看病，這樣一切都會簡單得多。

The cost to the patient is much cheaper in the UK, obviously.

[18] So how much did all this NHS care cost me? ￡0. Nothing. Zero. I paid not a penny for some top-notch healthcare. There is no such thing as a “free,” of course, but the per-capita cost of healthcare in the UK (paid by the government via tax collections) is generally lower than the US, according to the World Health Organization.Americans spend $8,362 per capita on healthcare annually, the Brits spend$3,480. Here is a breakdown5breakdown細(xì)目。:

NHS prices

● Doctor visit: ￡0

● Specialist: ￡0

● Diagnostic test: ￡0

● MRI: ￡0

● Total: ￡0

Typical US prices

● Doctor visit: $100

● Specialist: $150

● Hearing test: $72

● MRI: $1,000

● Total: $1,322 (Total payable by the patient in cash, or typically 90% from insurance and 10% as a patient copay6= copayment共付額，指被保險人用于就醫(yī)或配藥所支付的固定費(fèi)用。.) ■

顯然，在英國看病花費(fèi)少得多。

[18]那么，這次在NHS看病，花了我多少錢？0英鎊，一點(diǎn)兒都沒花。哪怕是一些一流的醫(yī)療服務(wù)，我也一分錢沒花。當(dāng)然，沒有什么“免費(fèi)”一說。但世界衛(wèi)生組織的數(shù)據(jù)顯示，英國人均醫(yī)療開支（由政府通過稅收支付）通常低于美國。美國年人均醫(yī)療開銷為8362美元，而英國為3480美元。且看價格明細(xì)：

NHS價目

● 門診掛號費(fèi)：0英鎊

● 專科醫(yī)生掛號費(fèi)：0英鎊

● 診斷性檢查：0英鎊

● 核磁共振：0英鎊

● 總計：0 英鎊

美國一般價目

● 門診掛號費(fèi)：100美元

● 專科醫(yī)生掛號費(fèi)：150美元

● 聽覺檢查：72美元

● 核磁共振：1000美元

● 總計：1322美元（患者可用現(xiàn)金全額支付，或者選擇90%保險加10%自付。） □